Member Rights and Responsibilities

Company and Provider Information

You have the right to …

  • Receive information about Empower, including services, benefits, practitioners, providers, member rights and responsibilities and clinical guidelines

Respect

You have the right to …

  • Be part of decisions about your care plans, including your right to refuse treatment
  • Execute your advance directives without fear of being treated unfairly
  • Receive a copy of your rights and responsibilities
  • Tell us what you think your rights and responsibilities as a member should be
  • Be treated with respect, dignity, and privacy no matter what
  • Have anyone you choose to speak on your behalf
  • Decide who will make medical decisions for you if you cannot make them
  • Understand your Person-Centered Service Plan (PCSP) and receive the services listed in it
  • Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience, or retaliation
  • Live in an integrated and supported setting in the community and have control over aspects of your life
  • Be protected in the community
  • Exercise your rights without having the quality of your care affected

Communication

You have the right to …

  • Get information about services, benefits, or providers, care guidelines, and member rights and responsibilities
  • Receive written notice of changes regarding your care coordination provider within seven days
  • Receive a member handbook and provider directory soon after enrollment
  • Talk with your provider about your treatment options without cost or coverage being factors
  • Know about covered services, benefits, and decisions about health care payment with your plan, and how to find these services
  • Obtain information regarding your own treatment record with signed consent in a timely manner
  • Provide input to Empower
  • Request and receive a copy of your medical records and request that they be amended or corrected
  • Receive information on available treatment options and alternatives, and have this information given in understandable and appropriate way
  • Oral interpretation services free of charge for any Empower materials in any language

Complaints

You have the right to …

  • Make complaints (verbally or in writing) about staff, services, or the care given by providers
  • Appeal if you disagree with a decision about your care. Empower administers your appeal rights as stipulated under your benefit plan

Confidentiality

You have the right to …

  • Keep communication about your health information private

Access to Care, Services, & Benefits

You have the right to …

  • Receive timely care consistent with your need for care
  • Choose a participating provider for any service for which you are eligible and authorized to receive under your PCSP, including your primary care provider
  • Obtain needed, available, and accessible health care services covered under Empower

Claims and Billing

You have the right to …

  • Know the facts about any charge or bill you receive

MEMBER RESPONSIBILITIES

You have the responsibility to …

  • Provide information, to the best of your ability, which Empower, or your provider may need to plan your treatment.
  • Learn about your condition and work with your provider to develop a plan for your care. You have the responsibility to follow the plans and instructions for care you have agreed to with your provider.
  • Understand your benefits, what is covered and what is not covered. You are responsible for understanding that you may be responsible for payment of services you receive that are not included in the Covered Services List for your coverage type.
  • Notify Empower and your provider of changes such as address changes, phone number change, or change in insurance.
  • Contact your Behavioral Health Provider, if you have one, if you are experiencing a mental health or substance use emergency.

If required by your benefit, you are responsible for choosing a primary care provider and site for the coordination of all your medical care.